Saturday, 26 March 2016

A Simple Guide To Newborn Sleep

A Guide To Newborn Sleep

In the Words of Dr. Harvey Karp “Your babies nine months – or three trimesters – inside you is a time of unbelievable complex development.  Never less, it takes a baby an additional three months to “wake up” and become active partners in the relationship.  This time between birth and the end of your baby’s third month is what I call your baby’s fourth trimester.”

            As a sleep consultant and from a mother’s perspective I love looking at newborn sleep as a 4th trimester chunk of time.  I feel strongly that our babies have been inside our womb for 9 months and so all they know and recognize is you! As parents, it is our job to gently introduce them to their new way of life outside the womb.  This includes helping them learn healthy sleep habits which in turn leads to reaching healthy sleep goals that nourish their rapidly growing bodies!

            During the first 4 months of your baby’s life sleep is not always easy!  Baby sleep is a windy and bumpy road.  There is no straight, easy, logical way about it.  You may have heard somebody say “I slept like a baby!” and thought to yourself ‘hopefully not like my baby or you would be exhausted!’  So, what does “sleeping like a baby” really mean??

            Newborn sleep is erratic and often doesn’t show any sort of pattern until around the 4 month mark when they go through a major sleep milestone and their sleep cycles begin to fully develop.  Before this 4 month mark babies tend to sleep often and they may require some help from you to get the sleep they need.  You may notice that as the weeks go by they begin staying awake for longer periods of time and you may notice sleep becoming a little more difficult in terms of taking longer to fall asleep, shorter naps, increaed fussiness and more frequent night wakings.  This is perfectly normal as the body adjusts to the longer periods of wakefulness and the body develops.  Don’t be discouraged!  Instead use the tips below to get the next sleep period or next day back on track.  You may also begin to see that some of the longer spurts of sleep may be happening at night versus happening sporadically.  This often happens in the early part of the night when we adults are still awake but it still is showing that your baby’s body clock is shifting to more sleep at night and less during the day.

** The main goal for the “fourth trimester” is to make sure your baby is getting the sleep that they need.

How Much Sleep Does My Baby Need?
Babies need A LOT of sleep!!  Much more than parents anticipate.  Here is a little breakdown:

Newborn – 2 months
Total Sleep: 16-20 hours
Day Sleep: 7-9 hours
Night Sleep: 8-9 hours

2-4 Months
Total Sleep: 14-18
Day Sleep: 5-7 hours
Night Sleep: 8-10 hours

Sleep Tips to Help Reach Baby’s Sleep Recommendations

            As mentioned above, we are all our baby knows!!  They have been inside our womb for what has been their entire life.  This is why I am a big fan of recreating the world that they know and feel safe in…..the womb!!  Help them learn healthy habits by using what they already know and gradually introducing new things as well. 

            Here are some guidelines to follow for your new baby to ensure that they are getting the sleep that they need!  If you have a baby on the way this is great to know beforehand but if your bundle of joy is here already then you can begin implementing some of these practices now!!

1. Follow the 5 S’s

The 5 S’s are based on the notion that recreating the womb for our babies allows for a gentle transition to our outside world.  Dr. Karp, the doctor who came up with this concept, believes that by following these 5 S’s you can soothe a fussy baby in no time by triggering their internal “calming reflex” which helps lead to more sleep.

A. Shushing – There is a wide belief that inside the womb is quiet.  The opposite is actually true.  There is blood flow happening all around your baby while they are in the womb and so they hear A LOT of constant noise.  By doing loud “Shhhhhhhh” or “Shhh, shhhh, shhhh, shhh” close to your babies ear you are re-creating a calming sound that they are familiar with. (More on this with white noise).

B. Swaddling – Our wombs really do not have that much space in them.  It is tight and compact and our little babies get to feel like they are wrapped up tight for the length of time they are inside.  When babies are born they do not have control over their limbs and so you may notice their arms and legs moving in jolt like movements.  These are reflexes and these reflexes OFTEN wake a sleeping baby.  Swaddling your baby mimics that safe, comfortable feeling in the womb and it also prevents these jolty reflexes from waking them up. 

C. Swinging – When baby is in the womb there is also constant movement….well during the day.  This movement lulls your sweet baby to sleep while they are inside of you. Using motion to help your baby get the sleep they need is a great idea if they like it!!

  • For sleep put your baby in the swing and let the swing motion put your baby to sleep.  It often works best to turn the swing on its highest speed as this is most similar to the womb (I know it seems fast but it really isn’t)

  • If you are trying to calm your baby in your arms do a more jiggly type of motion.  As you are holding them swaddled and belly to belly, begin to jiggle your arms quickly up and down.  It is the fast, jolty motion that mimics the womb when you are trying to calm them.  This works!!
D. Side Lying – When your baby is sleeping it is always safest to put them on their backs to sleep as recommended by your family doctor and the National Sleep Foundation!!  When you are trying to calm your baby in order for them to fall asleep holding them in a side lying position so their belly is against your belly is a great holding position to help trigger that calming reflex.   

E. Sucking – New babies often do a lot of sucking reflexes as newborns.  This is when they are hungry and it also triggers that calming reflex.  Pacifiers can help greatly with this.  When you are trying to soothe a fussy baby using a pacifier with the above tactics can help your baby settle so that they can fall asleep.  If they fall asleep with the pacifier try not to replace it if it falls out but instead use other soothing techniques.  This can avoid the pacifier association that often occurs in older infants.

** The key to the 5 S’s is combining them!  One by itself may not work but by using a combination this is a very successful method to calming your baby down which will make it easier for them to fall asleep.

2. Don't Keep Your Baby Awake Too Long

You may be wondering how on earth you’re going to get your baby to sleep the amount of sleep hours that I recommended above!  16-20 hours for a newborn and 14-18 for 2-4 month old seems crazy!  As adults we go day to day not even realizing all of the stimulation that our bodies get.  Babies on the other hand have never had this stimulation and so it is a MAJOR factor in their development and sleep. 
**Keep in mind that a lot of brain development occurs during sleep**

By limiting the time your baby is awake in between sleep sessions allows you to control the amount of stimulation their little body receives and prevents them from becoming overtired!  Overtired babies DO NOT SLEEP WELL!!

Follow these suggestions for your little one:

0-1 Month – Babies here will be sleeping all of the time.  Rule of thumb is to have them awake the duration of their last sleep period or up until a max of 45 minutes (closer to 40 minutes is even better!).  For example, if your baby only slept for 30 minutes then we would want them sleeping again in 30 minutes but if they had a 2 hour nap then the max we would keep them awake for is 45 minutes and so we would want them ASLEEP by the 45 minute mark.

1-2 Months – Your baby may be beginning to stay awake for slightly longer periods of time.  The awake time here is duration of their last sleep period or up until a max of 60 minutes (closer to 50 is even better!)  For example, if your baby slept for 45 minutes you would want them asleep again by 45 minutes but if they had a 2 hour nap then their new max time is 60 minutes and so we would want them ASLEEP by at least this time.

2-3 Months – Every month they are becoming more alert!  Awake time is duration of their last sleep period or up until a max of 80 minutes (closer to 70 is even better!).

3-4 Months – Your little baby is becoming quite the character!! Awake time is duration of their last sleep period or up until a max of 90 minutes.

** Having your baby asleep following the above suggestions can make a huge difference in sleep quality for your little one!

3. Identify Your Baby’s Sleepy Cues

For infants there is a lot of clock watching to prevent them from becoming overtired but we should also be watching their individual cues!  If you notice sleepy signals before your goal wake time (listed above) then this is a sign that your baby is ready to go to sleep earlier.  This is O.K.!  Remember, they need A LOT of sleep! 

Signs to watch for include: becoming still, staring into space, getting fussy, rubbing eyes, eyes/eyebrows becoming red, or when your baby is being quiet but lets out a single whine/cry. 

These are all signs that it is time for your baby to be sleeping, even if it is earlier than your expected wake time.  Stimulation levels are always different which means they may need some earlier sleep times and some later ones.

4. The E.A.S.Y Routine

E – Eat
A – Activity
S – Sleep
Y – You time!

The not so easy…easy routine!  During the first month your baby will be waking up to eat, be changed, and then will be going back to sleep.  Often times your baby will drift off back to sleep during the feeding and this is normal! As the days go by and you begin to notice your baby staying awake for longer amounts of time it is good to be conscious of the E.A.S.Y routine!  What this does is help prevent a milk to sleep association.  When an older baby has a milk to sleep association they often wake frequently during the night for a quick snack and then go back to sleep.  This can be very tiring for both baby and the parents!  You would follow this routine throughout the day after each waking.  When they wake you would feed them, then do some light stimulation via a diaper change and some talking/playing, then before your wake time is up you can swaddle them up and do a quick routine to help them fall back asleep for their next sleep time. 

Implementing this strategy with my second child made a huge difference in quality of sleep that in our home!

** Please note that if you really enjoy having your baby fall asleep while cuddling them with a bottle or nursing them then please continue to do this.  This is just one suggestion that I have to help in the upcoming months but every family and baby is different.

5. Establish a Healthy Room Environment

Sleep environments are so important to sleep.  As adults we like to have our bed, our pillow, and our blankets and so why wouldn’t our babies??  It does not matter what you choose for your baby in terms of where they are sleeping but it is helpful to include some things in the room that they are in to help with sleep.

White Noise – White noise is a very similar concept to the shushing outlined above!  It mimics the sounds of the womb which help your baby to relax.  If we think about it from our baby’s point of view they came from a noisy environment to a place where everyone is trying to keep things quiet.  Having white noise on in their sleep environment can help re-create their safe place!  Don’t forget that this sound can help to block out disturbing noises from inside and outside your home!

Create a Sleep Cave! – Days & Nights are influenced by light levels.  As outlined above darkness signals our body to sleep and light signals our body to be awake.  Although newborns don’t have the sleep hormones to regulate their sleep cycles until around the 4th month the light can still act as stimulation.

 Increasing stimulation during the day by having them spend time in the natural sunlight and decreasing stimulation at night by eliminating light sources helps their bodies to learn when in a 24 hour period is day time and when is night time.  For naps, we also want to have to sleeping environment dark so their body has the same cues to sleep as night time.  As your baby gets older the darkness will help cue the body to sleep which allows them to fall asleep more quickly and stay asleep.

For the last 9 months your baby has been living in a permanent dark environment and so they have not had to differentiate day from night.  By using the light stimulation we can help regulate their days.

** Having a dark sleep cave works for adults too!  If you are finding yourself having troubles check your sleeping environment to make sure no light is getting in!

6. Establish a Soothing Ladder

This is a gentle method that you can begin implementing early in your baby’s life.  It is meant to take place during the night to help your baby gain independence in falling back asleep by using a structured soothing ladder to help meet their needs.  A 1 month old baby will wake frequently during the night for feeds and that is great but I would still implement a soothing ladder to get them used to the other soothing techniques even though they WILL get their feed. 

I like this method because at each waking it may be a different step that will soothe your baby and your little one may surprise you and fall asleep at one step you least expect! 

A soothing ladder starts with the least intrusive method of soothing up until the big guns of feeding them.  It looks something like this:

Every time your baby wakes you would start from the bottom and work your way up to the top.  The length of time you spend on each level may vary depending on how long has passed that they have been sleeping.  For example, if you know it is time for a feed I would spend a quick 10-15 seconds on each step and then feed your baby.  If your baby just fed 45 minutes ago then spend more time (1-2 minutes) on each step to see if something else soothes them.  Don’t feel like you have to go all the way up the ladder!  If your baby is calming then stay on that step.
Your little one is going to change so fast and so this soothing latter can help you keep track of their needs and capabilities of falling asleep.  Every time you implement the soothing ladder you are giving your baby an opportunity to calm with less intervention.

** Create a soothing ladder based on what you know your baby likes going from least to most intervention.
** This method works for the first 4 months.

The first months following the birth of your baby can be challenging.  Each day will be different so I can’t stress enough to be confident in your parenting!! Take every day one at a time and if you have one bad day then try again the next day on more sleep.  You got this!  Before you know it your baby will be older, time really does fly.  Remember, the most important factor in the first 4 months to get your baby lots of rest….no matter how you do it!  parents always know best!

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Soothing Ladder image taken from: "The Good Sleeper" by Janet Krone Kennedy

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